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DERS (reproductive) > L44- Female GUT Pathology III (vagina) > Flashcards

L44- Female GUT Pathology III (vagina) Flashcards

1
Q

Vagina:

  • (1) size
  • (2) simple definition, anatomically
  • (3) embryonic origin
A

1- 2.5-3 in long

2- muscular tube between vulva and cervix

3:

  • Mullerian ducts – upper 3/4ths vagina
  • Urogenital sinus – lower 1/4th vagina
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2
Q

Uterine didelphys: definition and origin

A
  • two uteri, two cervices, two vaginas

- TOTAL (not partial) failure of mullerian ducts to fuse

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3
Q

list the vaginal lesions (not vulva)

A
  • Gartner’s duct cyst
  • Adenosis, clear cell carcinoma
  • SCC
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4
Q

list the vulva lesions (not vagina)

A
  • Bartholin’s cyst
  • nonneoplastic epithelial disorders
  • condyloma acuminatum (genital warts)
  • extramammary Paget’s disease
  • VIN, SCC
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5
Q

Gartner’s duct cyst:

  • (1) size and location
  • (2) origin / cause
A

1- anterolateral wall of vagina, 1-2 cm

2- mesonephric / wolffian ducts

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6
Q

Vaginal Adenosis is seen in girls at (1) age, with mothers with a (2) history. (3) is the development seen in the vaginal wall due to (4) dysfunction. (5) is the risk in some females.

A

1- 10 y/o
2- diethyl stillbesterol (DES) regimen during pregnancy to prevent abortion
3- endocervical type glands
4- inhibition of Mullerian epithelial transformation into squamous epithelium
5- clear cell adenocarcinoma (10-35 y/o)

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7
Q

SCC of the Vagina:

  • (un-/common)
  • (2) cause, with (3) lesion initially
  • (4) mass description
  • (5) is also evaluated
  • (good/poor) prognosis
A

1- uncommon
2- high risk HPV [16, 18, 31, 33]
3- vaginal intraepithelial neoplasia (VIN 1,2,3)
4- exophytic, polyploidal, fungating mass
5- pelvic / inguinal LNs
6- poor prognosis

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8
Q

Sarcoma Botryoides:

  • aka (1)
  • (2) affected age group
  • (3) general appearance (based on name)
A

1- embryonal rhabdomyosarcoma
2- <5y/o
3- Botryoides = ‘bunches of grapes’ hanging w/in vagina

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9
Q

Sarcoma Botryoides:

  • aka (1)
  • (low/high) malignant
  • (3) microscopic appearance
  • (4) type invasion / spread
  • (5) Tx
A 
1- embryonal rhabdomyosarcoma
2- highly malignant
3- maligant rhabdomyoblasts, cambium layer, fibromyxomatous
4- local invasion
5- surgery, chemotherapy
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10
Q

list the components of the vulva

A
  • labia majora, minora
  • vestibule
  • clitoris
  • Bartholin glands (open into vaginal introitus/opening)
  • Skene glands (around urethral opening)
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11
Q

Vulvar Vestibule components

A
  • vaginal opening = introitus
  • urethral opening
  • major vestibular / Bartholin’s glands
  • minor vestibular glands, periurethral Skene’s ducts (homologues of prosate gland, immediately adjacent and posterolateral to urethral)
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12
Q

Bartholinitis:

  • (1) definition resulting from (2)
  • (3) causes
  • (4) and (5) may develop
  • (6) Tx
A

1- acute inflammation, inferior labia majora
2- Batholin gland obstruction

3- Strep. spp, Staph. spp, Gonococci, E. Coli

4- vaginal blocking
5- abscess formation
6- drainage and marsupialization (special surgery)

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13
Q

Condyloma acuminatum = _____ + description

A

Genital Warts: bulky, warty growth

  • possibly multiple
  • hyperplasia, koilocytosis
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14
Q

Leukoplakia:

  • (1) definition
  • (2) causes
  • (3) clinical importance
A

1- white plaques associated with pruritus and scaling

2: (neoplastic and non-neoplastic)
- inflammatory dermatoses (psoriasis)
- Lichen sclerosus, squamous cell hyperplasia
- Neoplasia: vulva intraepithelial neoplasia (VIN), Paget’s disease, invasive carcinoma

3- biopsy to r/o neoplastic cause

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15
Q

Lichen sclerosus = (1):

  • (2) common age of onset
  • (3) type disease pathogenesis
  • (4) risk of carcinoma
A

1- Kraurosis vulvae

2- postmenopausal

3- autoimmune nature

4- slightly inc risk of carcinoma over leukoplakia alone

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16
Q

Lichen sclerosus morphological changes

A
  • thinning of epidermis
  • Rete Peg disappearance
  • Dermal fibrosis (dense collagen)
  • band-like inflammatory infiltrates

-**Leukoplakia: scaly white plaques, parchment like

17
Q

Squamous Cell Hyperplasia on vulva = (1):

  • (2) common age of onset
  • associated with (3) symptom
  • (4) malignant potential
A

1- Lichen simplex chronicus
2- post-menopausal
3- pruritus and chronic irritation of vulva
4- NONE

18
Q

Squamous Cell Hyperplasia of vulva morphological changes

A
  • acanthosis, localized hyperplastic epidermis, hyperkeratosis
  • inflammatory infiltrates
  • inc mitotic activity, no atypia
19
Q

Paget disease of vulva:

  • (1) = primary
  • (2) = secondary
A

1- adenocarcinoma in-situ or invasive

2- due to underlying malignancy –> GYN, GI, GU in 15-30% cases

20
Q

list VIN risk factors (include age), classic type

A

(vulvar intraepithelial neoplasia)

  • HPV 16, 18, 31, 33 (high risk)
  • mean age ~40 y/o
  • smoking
  • immunosuppressed patients
21
Q

VIN, classic type:

-(1) is main appearance with a (2) distribution

A

(vulvar intraepithelial neoplasia)
1- Leukoplakia, reddish brown plaque

2:

  • 50-80% multifocal
  • 50-60% synchronous lesions in cervix, vagina, urethra, anus
22
Q

VIN, classic type:

  • (1) odds of recurrence after local Tx, more likely in (2) patients
  • (3) risk of invasion after Tx
  • (4) is the ultimate Tx
A 
(vulvar intraepithelial neoplasia)
1- 35-50%
2- younger patients
3- 4-7%
4- surgical excision
23
Q

VIN, differentiated type:

  • (1) main cause
  • (2) mainly affected group
A

(vulvar intraepithelial neoplasia)
1- p53 mutation (not HPV)
2- older women

24
Q

VIN, differentiated type appearance / make-up

A

(vulvar intraepithelial neoplasia)

  • basal atypical layer - basal cell atypia
  • maturation of superficial layers, hyperkeratosis
  • in-site lesion w/o invasion
25
Q

Carcinoma of Vulva:

  • (1) most affected group
  • mostly (2) type in (3) location and (4) character
  • (5) are also investigated in these cases
A 
1- >60y/o
2- SCC: keratinizing, basiloid types (keratin pearls, intracellular bridges)
3- anterior 2/3 labia majora
4- plaque or nodule or ulcer
5- inguinal and pelvic nodes
26
Q

Vulva SCC, keratinizing type:

  • (more/less) common than than basaloid SCC
  • mostly (older/younger) females
  • (uni/multi)-focal
  • (rare/common) associated multifocal lower GUT neoplasia
  • (5) morphology
  • (rare/common) associated VIN
  • (7) associated HPV
  • (rare/common) associated vulvar dystrophy
  • (9) IHC markers
A 
1- more, 80%
2- older
3- usually unifocal (or multifocal)
4- rare
5- keratinizing
6- rare (differentiated type)
7- HPV-β (cutaneous)- 5, 8
8- common
9- p53+ (some cases), p16(+/-)
27
Q

Vulva SCC, basaloid type:

  • (more/less) common than than keratinizing SCC
  • mostly (older/younger) females
  • (uni/multi)-focal
  • (rare/common) associated multifocal lower GUT neoplasia
  • (5) morphology
  • (rare/common) associated VIN
  • (7) associated HPV (+ type)
  • (rare/common) associated vulvar dystrophy
  • (9) IHC markers
A 
1- less, 25%
2- younger
3- multifocal
4- common
5- worly
6- common (classic type)
7- HPVα- 16 > 18
8- rare
9- p53-, p16+
28
Q

list the different Gestational trophoblastic disease- **indicate the main marker

A
  • Hydatidiform mole- complete/incomplete
  • invasive mole
  • gestational choriocarcinoma
  • placental site trophoblastic tumor

-**β-hCG in urine, serum is critical marker

29
Q

define hydatidiform mole

A

Uterus:

  • filled with translucent grape-like clusters of edematous, distorted structures
  • deficiency of fetal BVs (no fetal development)
30
Q

Hydatidiform mole:

  • (1) age/geographic risk factors
  • (2) types
  • (3) 3 key characteristics
A

1- extremes of age, Far East countries

2- partial or complete

3:

i) large edematous, avascular villi
ii) stroma degeneration
iii) trophoblast proliferation

31
Q

Complete Mole:

  • (1) genomic status of ovum
  • (2) morphological changes
  • (3) physiological marker
  • small risk of developing (4)
A

1- loss of chromosomes of ovum –> fertilized by 2 sperm or 1 diploid sperm => mostly 46XX, rarely 46XY

2- (embryo dies early, no fetal parts seen) enlarged uterus filled with grape like vesicles

3- β-hCG (may produce bilateral theca lutein cysts)

4- choriocarcinoma (2%)

32
Q

Partial Mole:

  • (1) genomic status of ovum
  • (2) morphological changes
  • (3) malignancy risk
A

1- fertilized by two (23X, 23Y) sperms => triploid (69XXY) mole

2- (short embryo development, some fetal parts seen) minimally enlarged uterus

3- no risk of malignancy

33
Q

Hydatidiform mole:

  • (1) main signs and Sxs
  • (2) can develop after 3-4 mos
A

1- amenorrhea (enlarged uterus), vomiting, positive pregnancy test

2- vaginal bleeding, grape-like structures

34
Q

Hydatidiform mole:

  • (1) US appearance
  • (2) physiological test
  • (3) Tx
  • (4) monitoring
A

1- snowstorm appearance, absent fetus if complete

2- elevated β-hCG, serum/urine

3- curettage for lesion removal

4- β-hCG levels (10% persistent/invasive, 2% choriocarcinoma)

35
Q

Invasive mole:

  • (1) frequency
  • (2) definition
  • (3) associated features
  • (4) is important risk / development
  • (5) Tx
A

1- 10% of complete moles

2- deep invasion of villi, trophoblasts –> myometrium

3- necrosis, hemorrhage of myometrium

4- uterine rupture (requires hysterectomy) –> villi embolize in the lung (regress)

5- chemotherapy

36
Q

Gestational Choriocarcinoma:

  • (1) geographic risk
  • 50% develop from (2), 25% from (3)
A

1- more in Asia, Africa than USA

2- hydatidiform mole

3- abortion, normal pregnancy, ectopic pregnancy

37
Q

Gestational Choriocarcinoma:

  • (1) mass description
  • (2) usual presentation
  • (3) Tx
A

1- not bulky, uterine bleeding

2- advanced presentation –> lung, vagina, brain, kidney affected

3- evacuation + chemotherapy

38
Q

Gestational Choriocarcinoma:

  • (1) are malignant, (2) are absent
  • (3) is initial screening followed by (4)
  • (5) monitoring
A

1- cytotrophoblasts, syncitiotrophoblasts

2- chorionic villi

3- β-hCG elevated

4- biopsy

5- β-hCG

DERS (reproductive) (14 decks)

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